Results of living-related kidney transplantation in Puerto Rico.

A total of 103 kidney transplantations from living-related donors were performed in the Puerto Rico Kidney Transplant Program between January 1977 and June 1984. The majority of these patients were male, 76% were between 21 and 50 years of age, 33% were indigent, and 38% were either black or of mixed race. Rigid exclusion criteria were established in the selection of kidney donors. All donor operations were at least 2-antigen-compatible. Surgical technique and posttransplant management were standard, except that in 1980 the immunosuppressive policy was changed as follows: posttransplant prednisone was very rapidly tapered to 20 mg/day at two weeks after transplantation and antilymphocyte globulin was used to treat all rejections. The overall 3-year patient survival for the 7 1/2 years is 91.6%, but after 1980 it increased to 98% perhaps a reflection of the changes in immunosuppressive policy. Eight of ten deaths were due to sepsis, most of them related to rejection treatment. The 3-year kidney survival was 77%. All kidney losses were due to rejection. A low incidence of urological complications is reported. There were no technical losses. A relatively low incidence of cancer is reported. Cutaneous mycosis is highly prevalent in our patients, but systemic fungi are virtually absent.